Compartment Syndrome? Forefoot Striking to the Rescue

Pete Larson of Runblogger has a great summary of a new study in the American Journal of Sports Medicine, in which 10 West Point cadets suffering from compartment syndrome were retrained to run with a forefoot landing rather than heel-striking. The results are impressive: after six weeks of form training (three times a week for 45 minutes), all 10 of the runners dramatically increased the distance they could run without pain (from 1.4 to 4.8 km). A year later, eight of the 10 runners were still running at least 5 km at a time; the only two exceptions were due to a torn ACL and a sprained ankle.I won't rehash the details of the study here -- Pete's post does a great job of presenting the findings and putting them in context. Just two comments:1. To me, this is a significant step forward in the debate. A few months ago, Dan Lieberman presented some interesting data on injury rates in rearfoot and forefoot strikers on the Harvard XC team. This goes a step farther, by actually changing footstrike and observing clinical changes as a result. Is it proof that we should all forefoot strike? Far from it -- it's a small, uncontrolled study (actually, strictly speaking, it's not even a "study"; it's a "case series"). But if I was struggling with compartment syndrome, I'd sure as heck find these results very, very interesting.2. My main criticism of the study is something that Pete also points out: they didn't just change one element of the runners' stride, they did a whole kitchen sink's worth of changes. From the study:

The intervention in this study was instruction and training to adopt a forefoot strike running technique... Additional emphasis included increasing the running step rate to 3 steps per second and using the hamstrings muscle group to pull the foot from the ground versus push the foot off the ground using the gastrocnemius and soleus muscles. Specific training drills and exercises designed to teach forefoot striking consisted of weight shifting, falling forward, foot tapping, high hopping, and running with the EZ run belt (Pose Tech Corp, Miami, Florida) and are described previously. The patients also practiced running barefoot and were provided with verbal cueing to ‘‘run quietly’’ to eliminate the tendency to heel strike upon ground contact. A digital metronome was utilized to stabilize step cadence at 180 steps per minute.

There's a lot going on there. My personal feeling is that overstriding may be the most serious running flaw associated with injuries -- something that can be addressed by increasing cadence -- and that footstrike may be more or less irrelevant if you're not overstriding. But we can't tell which matters here, because the researchers changed stride length, cadence and footstrike (among other things) all at the same time. Here are the idealized "before and after" diagrams they provide in the paper:BEFORE:

AFTER:There's a lot more than just footstrike changing there! Basically, it appears as though these runners were trained in the "Pose" method of running -- not surprising, given that the lead author of the paper, Angela Diebal, is a certified Pose instructor. It's certainly nice that they're testing the efficacy of Pose teachings, but to me, it would have been more useful if they'd changed one variable at a time, so we could identify the crucial factors. Still, it's an interesting study, and I look forward to follow-ups.